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Reproductive > Pathology - Zafar > Flashcards

Pathology - Zafar Flashcards

1
Q

Breast Embryology

A
  • largest skin gland: modified sweat gland
  • at the end of first month, a solid bud develops and invaginates into underlying mesenchyme
  • primary bud gives off several secondary buds that develop into lactiferous ducts which branch off further to form mammary gland
  • during pregnancy the breast assumes it’s complete morphologic and functional maturity
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2
Q

Breast Anatomy

A
  • symmetric double organ
  • reaches normal size b/w 16-19 yrs
  • b/w 2nd & 6th ribs and sternum and axilla
  • nipple & areola, superficial skin
  • breast is divided into 10-20 lobes, each lobe (lobules: ducts+acini=TDLU)
  • embedded in stroma
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3
Q

Breast Pathology: Classification

A

congenital or acquired

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4
Q

Accessory Breast Tissue

A
  • in axillary fossa

- tumors here may be confused with ax. LN or mets

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5
Q

Ectopic Breast Tissue

A
  • may develop along mammary line

- failure of any portion of mammary ridge to involute

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6
Q

Macromastia

A

-excessive breast tissue

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7
Q

Nipple Inversion

A
  • associated with large pendulous breasts

- may be confused with CA

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8
Q

Supernumerary Breast/Nipples

A

-persistent epidermal thickenings along milk line from axilla to perineum

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9
Q

Acute Mastitis/Abscess

A

non-neoplastic-acquired

  • tender, associated with lactation
  • cracks in nipple
  • staph and strep (pyogenic bacteria)
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10
Q

Silicone Implants

A

non-neoplastic-acquired

  • for a fibrous capsule (synovial metaplasia)
  • gel may seep through intact implant shells
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11
Q

Fibrocystic Changes/Disease of Breast

A

non-neoplastic-acquired

  • considered a hyperplastic disorder
  • proliferative vs. nonproliferative (cystic)
  • women 25-45 (hormonal imbalance?)
  • decreased risk with OTC
  • increased mitotic and apoptotic rate
  • may hamper adequate/optimal mammography
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12
Q

Sclerosing Adenosis

A

~30 y/o

  • risk of CA 1.5-2x normal
  • associated with clustered microcal
  • low power diagnosis
  • rarely involved by LCIS
  • -if palpable called adenosis tumor
  • retains lobular architecture
  • 2 cell-layered
  • actin immunohistochemistry + (myoepithelial cells)
  • related lesion-Radial Scar
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13
Q

Atypical Ductal Hyperplasia

A
  • features suggestive but not diagnostic of DCIS
  • increased risk of carcinoma 2-4x5 times
  • rick equal in both breast-maybe multicentric
  • multilayering of cells with progressive loss of nuclear polarity, enlarged nuclei, and nucleoli
  • most authors require 2+ involved ducts to call DCIS
  • loss of heterozygosity to 16q (40% clonal)
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14
Q

Atypical Lobular Hyperplasia (ALH)

A
  • resembles LCIS but does not fill or distend 50% or more acini within a lobule
  • has focal preservation of luminal spaces
  • 4x5 usual risk of CA in either breast (greater in pre-menopausal)
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15
Q

Fibroadenoma

A

-most common benign tumor (breast mouse)
~20-35 age women (younger)
-Fibradenomatosis
-may have a neoplastic stromal component with polyclonal epithelial component
-hormonally responsive: may grow in pregnancy
-malignant transformation <0.1%

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16
Q

Fibroadenomatosis

A

-multifocal disease in post renal transplant and with EBV in immunosuppressed

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17
Q

Fibroadenoma: Gross Appearance

A
  • sharply circumscribed

- freely mobile

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18
Q

Fibroadenoma: Microscopic

A
  • stromal & epithelial component
  • glandular epithelium without atypia
  • myoepithelial cells are present
  • stroma generally not very cellular (dd Phyllodes) but may have other stromal elements like cartilage, muscle
  • coexisting features: fibrocysitc change, sclerosing adenosis
  • FNAC very helpful in regular variant
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19
Q

Large Duct Papilloma

A
  • 48y/o, solitary, close to nipple-lactiferous ducts & sinuses
  • 1.5-2x risk of cancer, colonal
  • serous/bloody nipple dischargee (80%), nipple retraction may be present
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20
Q

Large Duct Papilloma: Gross

A
  • <3cm
  • soft
  • hemorrhagic
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21
Q

Fibroadenoma: Juvenile/Giant cell variant

A

-adolescent, often bilateral, often very large and may have very cellular stroma and glands (dd phyllodes tumor)

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22
Q

Large Duct Papilloma: Microscopic

A
  • multiple papillae in complex arborizing pattern
  • calcification possible
  • myoepithelium present (S1000+)
  • malignant if severe atypia, abnormal mitosis, single cell layered, pseudostradification no vascular core or cribriform morphology
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23
Q

Large Duct Papilloma: Treatment

A

-surgical excision

24
Q

Fat Necrosis

A
  • trauma: patient may not give history
  • Generally related to lactation, pregnancy, or sports activity
  • may present as ill-defined mass
  • may show calcification
  • may cause puckering of skin
  • DD-carcinoma
25
Q

Gynecomastia

A
  • enlargement of male breast: hypertrophy & hyperplasia
  • increased estrogen to androgen ratio
  • puberty: alcohol, cirrhosis, drugs
  • button or disc-like stromal enlargement
  • periductal stromal edema or fibrosis “Halo” effect
26
Q

Genetics of Breast Cancer?

A
  • first degree relatives at increased risk
  • higher if relative has bilateral disease, early incidence in relative or >1 relative affected
  • heterogenous carriers for ataxia-telangiectasia
27
Q

Li-Fraumeni syndrome

A

germline p53 mutations

-25% patients effected

28
Q

BCRA 1 & 2

A 
1 (17q21)
2 (13q12)
-tumor supressor genes involved in familial cancer
-5-10% of breast cancer cases 
-1% of general population
29
Q

Cowden Disease

A
  • multiple hemartoma syndrome
  • 10q mutation
  • much increased risk
30
Q

Breast Cancer: Hormonal

A

increased risk:

  • early menarche
  • late menopause
  • nulliparity
  • having first child after 30
  • recent use of oral contraceptives
  • HRT (estrogen + progesterone) in postmenopausal women
  • physical inactivity
  • consumption of 1 or more alcoholic/day
  • postmeno. w/obesity or estrogen producing ovarian tumor
31
Q

Breast Cancer: Environmental

A
  • US > Japan/Taiwan (5:1), also N. Europe, fatty diet & heavy alcohol use
  • not associated with smoking
  • in blacks: higher stage, high nuclear grade, higher mortality rate, more frequent in women <40, more likely ER/PR negative
32
Q

Breast Cancer: Hormonal Receptors

A

-ER/PR - response to anti-estrogen therapy (Tamoxifen) and prognosis

33
Q

Breast Cancer: Local Spread

A
  • skin
  • nipple
  • chest wall
34
Q

Breast Cancer: Nodal Mets

A
  • axilla
  • supraclavicular
  • internal mammary
35
Q

Breast Cancer: Distant Mets

A
  • skeletal system
  • liver
  • lung/pleura
  • ovary
  • adrenal
  • CNS
  • lobular CA favors abdominal cavity/viscera*
36
Q

Breast Cancer: Treatment

A
  • surgery (lumpectomy/mastectomy)
  • radiation
  • chemotheraphy
  • anti-estrogen
  • Herceptin
37
Q

Breast Cancer: Histological Grading

A

-score of 3-9 Modified Bloom and Richardson System

38
Q

Breast Cancer: Her2 (c-erbB2)

A
  • overexpression with gene amplification
  • aggressive tumor behavior
  • IHC and FISH 0-3+
  • membranous staining
39
Q

Breast Cancer: Prognostic Factors

A
  • stage
  • tumor size
  • histologic grade
  • ax LN status
  • age <50 better
  • histologic type (tubular, cribriform, medullary (better), signet ring, inflammatory (worse))
  • skin invasion
  • nipple inversion
  • angiolymphatic invasion
  • fibrotic focus
40
Q

Breast Cancer: Predictive Variables

A
  • ER/PR & Her2 Status

- ploidy & S-phase fraction have no predictive value

41
Q

Breast Cancer: Axillary Lymph Node

A

-involvement most improtant prognostic factor for disease (free & overall survival & Rx regimen)

42
Q

Breast Cancer: Sentinel Lymph Nodes

A
  • first lymph node that receives breast drainage/mets
  • usually ventral group (level 1)
  • replacement for axillary dissection in T1 & T2 tumors
  • cluster size of 0.2-2mm may indicate significant axillary dz.
43
Q

Breast Cancer: Core Biopsy

A
  • alternative to open biopsy
  • large (14 gage 1st gen or 11g 2nd gen)
  • computer (stereostactic) or US guided
44
Q

Breast Cancer: FNAC

A

90% sensitive, 95% specific

  • fibrotic areas difficult to aspirate
  • false neg small tumors, tubular CA, cribriform CA
  • false + w/florid ductal hyperplasia
  • neg FNA with lingering suspicion - BX
45
Q

Breast Cancer: Frozen Section

A

-real time evaluation in surgery

46
Q

In-Situ

A

-stromal invasion is not seen

47
Q

Ductal Carcinoma in situ

A

-tumor confined to glandular component - no stromal invasion, BM intact
-tumor can spread along ducts
-4x more common than LCIS
-15-30% of all cancer - mammography
-assoc. with development of invasive cancer at or near the site
-Rx: surgery + radiation
-cytologic features for grading: low vs. high grade
low (0-10%) high (40%) progress

48
Q

Lobular Carcinoma in situ

A
  • generally incidental: no distinguishing features at gross exam and no microcal
  • 50-70% bilateral (vs. 10% for DCIS)
  • 75% multicentric
  • 30% risk of invasive disease in either breast (relative risk 9x normal) Invasive dz may be of ductal or lobular type
  • 5% have coexisten invasive cancer
  • lobular cancerization of ducts
  • minimal risk of dying from cancer if periodically examined
  • rx: watchful waiting vs. ip/bil mastectomy
49
Q

Comedo Carcinoma (DCIS Variant)

A
  • 1/3 multicentric, 10% bilateral
  • 40% progressive (invasive)
  • some patient have axillary mets
  • high grade cells with central necrosis
  • Her2 amplification, p53 mutation positive
  • ER/PR negative, aneuploid
50
Q

Paget’s Disease of Breast

A
  • from excretory ducts and extends into skin of nipple/areola
  • assoc DCIS/Invasive
  • 50% underlying lump/mass
  • Sir James Paget 1874
  • Large cells with clear cytoplasm, nucleoli and abundant mucin (PAS Strain)
51
Q

Ductal Carcinoma NOS

A
  • most common type (80%) scirrhous
  • penetrative (crab-like-cancer)
  • calcification
  • tumor may be fixed to the chest wall
  • tubule formation, Nuclear pleomorphism and number of mitoses: MBR grading
52
Q

Lobular Carcinoma

A
  • 10% of all breast cancers
  • 20% bilateral, often multicentric
  • mets to CSF, BM, GIT, Serosal surfaces, ovary, uterus
  • mass lesion may not be present
  • single (Indian) file/targetoid, usually low grade appearance, signet ring cells
  • morphologic variant forms
53
Q

Inflammatory Carcinoma

A
  • clinical diagnosis
  • enlarged edematous breasts
  • aggressive - need aggressive Rx
  • Peau d’orange-lymphatic occlusion-thickened skin
54
Q

Colloid Carcinoma

A
  • “mucinous cancer”
  • older women-slow growth
  • better survival than ductal (12+ years after therapy)
  • large lakes of mucin
55
Q

Tubular Carcinoma

A
  • 2-6% of all malignant tumors
  • well differentiated-very favorable prognosis
  • avg age 50 yrs(younger than ductal)
  • good prognosis even with lymph node +
  • 75% tubules (angulated)
56
Q

Angiosarcoma

A
  • usually younger women or older women (sp radiation)
  • poor prognosis
  • anastomosing vascular channels lined by atypical cells
  • low and high grade
57
Q

Carcinoma in Males (breast)

A
  • 1% the rate of women (10% in Egypt)
  • similar risk factors as women
  • usually painless subareolar mass
  • advanced stage presentation
  • prognosis same as women when stage-matched

Reproductive (14 decks)

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